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Diverticular Disease

Diverticular Disease...1421 N. State Street, Ste 203 Jackson, MS 39202 601/355-1234 Vicksburg 1815 Mission 66 Vicksburg, MS 39180 601/638-8801 Madison 106 Highland Way Madison, MS

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Page 1: Diverticular Disease...1421 N. State Street, Ste 203 Jackson, MS 39202 601/355-1234 Vicksburg 1815 Mission 66 Vicksburg, MS 39180 601/638-8801 Madison 106 Highland Way Madison, MS

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Diverticular Disease

©2011 GI Associates & Endoscopy Center. All rights reserved.

Fax 601/352-4882 • 800/880-1231www.msgastrodocs.com

Jackson1421 N. State Street, Ste 203

Jackson, MS 39202601/355-1234

Vicksburg1815 Mission 66

Vicksburg, MS 39180601/638-8801

Madison106 Highland Way

Madison, MS 39110601/355-1234

Albert F. Chiemprabha, M.D.Pierce D. Dotherow, M.D.

Reed B. Hogan, M.D.James H. Johnston, III, M.D.

Ronald P. Kotfila, M.D.Billy W. Long, M.D.

J. Trippe McNeese, M.D.Paul B. Milner, M.D.

Michelle A. Petro, M.D. Vonda Reeves-Darby, M.D.

Sara Rippel, M.D., Pediatric GIMatt Runnels, M.D.

Vishwanath N. Shenoy, M.D. James Q. Sones, II, M.D.

April Ulmer, M.D., Pediatric GIJames A. Underwood, Jr., M.D.

Mark E. Wilson, M.D.Cindy Haden Wright, M.D.

Keith Brown, M.D., PathologistSamuel Hensley, M.D., Pathologist

Page 2: Diverticular Disease...1421 N. State Street, Ste 203 Jackson, MS 39202 601/355-1234 Vicksburg 1815 Mission 66 Vicksburg, MS 39180 601/638-8801 Madison 106 Highland Way Madison, MS

Table of Contents���:KDW�LV�LW"���'LYHUWLFXORVLV���:KDW�FDXVHV�LW"���:KDW�DUH�WKH�V\PSWRPV"���:KDW�DUH�WKH�FRPSOLFDWLRQV"���'LYHUWLFXOLWLV���'LYHUWLFXODU�EOHHGLQJ���3HUIRUDWLRQ���+RZ�LV�GLYHUWLFXODU�GLVHDVH�GLDJQRVHG"���7UHDWPHQW�RI�GLYHUWLFXORVLV���:K\�ILEHU"���1XWV�DQG�VHHGV���6WLFN�ZLWK�LW����2WKHU�OLIHVW\OH�FKDQJHV���2WKHU�WUHDWPHQW���6XPPDU\

9

In summary…+DYLQJ�GLYHUWLFXORVLV�PD\�EH�XQFRPIRUWDEOH��EXW�QHHG�QRW�EH�D�VHULRXV�SUREOHP��%\�IROORZLQJ�\RXU�JDVWURHQWHURORJLVW·V�DGYLFH��UHSRUWLQJ�DQ\�XQXVXDO�RU�VHYHUH�V\PSWRPV��DQG�EHLQJ�WUHDWHG�HDUO\�IRU�FRPSOLFDWLRQV��\RX�FDQ�KHOS�\RXUVHOI�OLYH�ZLWK�WKLV�SUREOHP�ZLWKRXW�VHULRXV�FRQVHTXHQFHV�

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Page 3: Diverticular Disease...1421 N. State Street, Ste 203 Jackson, MS 39202 601/355-1234 Vicksburg 1815 Mission 66 Vicksburg, MS 39180 601/638-8801 Madison 106 Highland Way Madison, MS

Other Lifestyle changes5HJXODU�H[HUFLVH�DQG�SOHQW\�RI�IOXLGV��HVSHFLDOO\�ZDWHU��LQ�WKH�GLHW�KHOSV�SUHYHQW�FRQVWLSDWLRQ��$QG��SUHYHQWLQJ�FRQVWLSDWLRQ�UHGXFHV�WKH�FKDQFHV�RI�GLYHUWLFXOD�IRUPLQJ�DQG�KHOSV�DYRLG�FRPSOLFDWLRQV�IURP�WKRVH�WKDW�DUH�DOUHDG\�WKHUH��5HJXODU�H[HUFLVH�DOVR�KHOSV�SUHYHQW�FRQVWLSDWLRQ�

Other treatment$V�PHQWLRQHG�HDUOLHU��ZKHQ�FRPSOLFDWLRQV�RFFXU��RWKHU�IRUPV�RI�WUHDWPHQW�PD\�EH�SUHVFULEHG��LQFOXGLQJ�DQWLELRWLFV�WR�WUHDW�LQIHFWLRQ�DQG�RFFDVLRQDOO\��DQWLVSDVPRWLF�GUXJV�WR�PLQLPL]H�GLVFRPIRUW�IURP�FUDPSLQJ�

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Diverticular DiseaseWhat is it?'LYHUWLFXODU�GLVHDVH�LV�RQH�RI�WKH�PRVW�FRPPRQ�FRQGLWLRQV�RI�WKH������JDVWURLQWHVWLQDO�V\VWHP��DIIHFWLQJ�DSSUR[LPDWHO\����PLOOLRQ�$PHULFDQV��7KH�WHUP�GLYHUWLFXODU�GLVHDVH�LQFOXGHV�GLYHUWLFXORVLV�DQG�GLYHUWLFXOLWLV��ERWK�RI�ZKLFK�ZLOO�EH�GLVFXVVHG��$OWKRXJK�LW�FDQ�RFFXU�DW�DQ\�DJH��LW�LV�UDUH�DPRQJ�SHRSOH�XQGHU�DJH�����,W�LV�FRPPRQ�DPRQJ�WKRVH�RYHU����DQG�DIIHFWV�PRUH�ZRPHQ�WKDQ�PHQ��%\�DJH������������������������DERXW�����RI�WKH�SRSXODWLRQ�ZLOO�KDYH�GLYHUWLFXORVLV��%\�DJH�����WKH�SHUFHQWDJH�LQFUHDVHV�WR������

Diverticulosis'LYHUWLFXORVLV�LV�D�FRQGLWLRQ�LQ�ZKLFK�VPDOO�EDOORRQ�OLNH�VDFV�GHYHORS�LQ�WKH�FRORQ��7KH�VDFV�RU�SRXFKHV�������������EDOORRQ�RXWZDUG�IURP�WKH�LQVLGH�RI�WKH�FRORQ�ZDOO��$�VLQJOH��RXWSRXFKLQJ�LV�NQRZQ�DV�D�GLYHUWLFXOXP��ZKLOH�PDQ\�DUH�NQRZQ�DV�GLYHUWLFXOD��7KH\�PD\�RFFXU�DQ\ZKHUH�LQ�WKH�FRORQ��EXW�WKH�PRVW�FRPPRQ�ORFDWLRQ�LV�QHDU�WKH�HQG�RU�RQ�WKH�OHIW�VLGH�RI�WKH�FRORQ�

What causes diverticulosis?,W�WDNHV�\HDUV�WR�GHYHORS�GLYHUWLFXORVLV�DQG�LW�LV�WKRXJKW�WR�RFFXU�DV�D�UHVXOW�RI�KLJK�SUHVVXUH�LQ�WKH�FRORQ�IRU�H[WHQGHG�SHULRGV�RI�

1

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Page 4: Diverticular Disease...1421 N. State Street, Ste 203 Jackson, MS 39202 601/355-1234 Vicksburg 1815 Mission 66 Vicksburg, MS 39180 601/638-8801 Madison 106 Highland Way Madison, MS

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Diverticulosis is potentially preventable with a high fiber diet.

7

Is it true that nuts and seeds should be avoided? ,W�LV�D�FRPPRQ�P\WK�WKDW�SHRSOH�ZLWK�GLYHUWLFXODU�GLVHDVH�VKRXOG�DYRLG�DOO�QXWV�DQG�VHHGV��$�FRPPRQ�PLVXQGHUVWDQGLQJ�LV�WKDW�HYHQ�WKH�WLQ\�VHHGV�OLNH�WKRVH�LQ�WRPDWRHV�VKRXOG�EH�DYRLGHG��,W�LV�DQ�´ROG�ZLYHV·�WDOHµ��WKDW�RQH�RI�WKH�VHHGV�FRXOG�JHW�WUDSSHG�LQ�D�GLYHUWLFXODU�SRXFK�DQG�FDXVH�SUREOHPV��7KLV�LV�VLPSO\�QRW�WUXH��7KH�ERWWRP�OLQH�LV�WKDW�LW�LV�2�.��WR�HDW�IRRGV�ZLWK�VHHGV��0RVW�RI�WKH�WLPH�WKH\�FDXVH�QR�SUREOHPV��LQ�IDFW��VXFK�IRRGV�DUH�

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Stick with it!7KH�DYHUDJH�SHUVRQ�ZKR�LV�XVHG�WR�HDWLQJ�D�ORZ�ILEHU�GLHW�PD\�H[SHULHQFH�VRPH�LQWHVWLQDO�GLVFRPIRUW�ZKHQ�FKDQJLQJ�VXGGHQO\�WR�D�KLJK�ILEHU�GLHW��7R�DYRLG�WKDW��HLWKHU�DGG�KLJK�ILEHU�IRRGV�JUDGXDOO\�LQWR�\RXU�XVXDO�GLHW�RU�MXVW�´WRXJK�LW�RXWµ��0LQRU�GLVFRPIRUW�ZLOO�JR�DZD\�DV�\RXU�ERG\�DGMXVWV�WR�WKH�QHZ�KHDOWKLHU�GLHW�

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As with most health problems, the best “medicine” is prevention!

Page 5: Diverticular Disease...1421 N. State Street, Ste 203 Jackson, MS 39202 601/355-1234 Vicksburg 1815 Mission 66 Vicksburg, MS 39180 601/638-8801 Madison 106 Highland Way Madison, MS

Why fiber?Fiber is crucial to both the prevention and treatment of diverticulosis, because it helps prevent constipation, reduces the pressure inside the colon and keeps diverticulosis from becoming more extensive or severe.

Although fiber (or roughage) itself does not contain vitamins and minerals, it is an important part of the diet. It is not digested, but absorbs water, which makes the stool softer and bulkier.

Many foods are great sources of fiber. Raw fruits and vegetables, bran muffins, breads and cereals, as well as cooked peas and beans are good choices, but the amount of fiber in those foods varies quite a bit. The average American diet does not contain enough fiber. For good health, the current recommended level of fiber is between 30 and 40 grams per day, yet the average American diet contains only 15 to 20 grams per day.

Once you have diverticulosis, it is necessary to continue a high-fiber diet always, unless your physician recommends otherwise. When your gastroenterologist recommends a high-fiber diet, you will be given more information about high-fiber foods that will help you choose the best foods.

Sometimes, a dietary supplement will be prescribed to provide extra fiber. These are known as bulking agents. You may know some of those by brand name: Metamucil, PerDiem Plain, Effersyllium, Citrucel, Hydrocil Instant and Miller’s Bran.

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What are the symptoms of diverticulosis?0DQ\�SHRSOH�ZLWK�GLYHUWLFXORVLV�KDYH�QR�V\PSWRPV��$V�GLYHUWLFXORVLV�GHYHORSV�RYHU�D�ORQJ�SHULRG�RI�WLPH��PLOG�RU��VHYHUH�V\PSWRPV�PD\�GHYHORS��GHSHQGLQJ�RQ�WKH�H[WHQW�DQG�VHYHULW\�RI�WKH�FRQGLWLRQ��6RPH�SHRSOH�KDYH�VSDVP�OLNH�GLVFRPIRUW�LQ�WKH�ORZHU�DEGRPHQ��XVXDOO\�RQ�WKH�OHIW�VLGH��*DV��VWRPDFK�FUDPSV�DQG�FRQVWLSDWLRQ�ZLWK�RFFDVLRQDO�GLDUUKHD�DUH�DOVR�FRPPRQ�

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What are the complications of diverticulosis?2QFH�GLYHUWLFXOD�KDYH�GHYHORSHG��PDMRU�SUREOHPV�PD\�RFFXU��EXW�DUH�QRW�YHU\�FRPPRQ��7KH�WKUHH�PRVW�FRPPRQ�VHULRXV�FRPSOLFDWLRQV�DUH�GLYHUWLFXOLWLV��UHFWDO�EOHHGLQJ��DQG�SHUIRUDWLRQ��3DLQ��IHYHU�DQG�EOHHGLQJ��RU�D�FRPELQDWLRQ�RI�WKRVH��DUH�OLNHO\�WR�EH�D�SDUW�RI�VXFK�FRPSOLFDWLRQV��,I�\RX�KDYH�GLYHUWLFXORVLV�DQG�DQ\�RI�WKHVH�V\PSWRPV�RFFXU��\RX�VKRXOG�FRQWDFW�\RXU��SK\VLFLDQ�LPPHGLDWHO\��

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Page 6: Diverticular Disease...1421 N. State Street, Ste 203 Jackson, MS 39202 601/355-1234 Vicksburg 1815 Mission 66 Vicksburg, MS 39180 601/638-8801 Madison 106 Highland Way Madison, MS

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How is diverticular disease usually diagnosed?7KH�SK\VLFLDQ�XVXDOO\�GLDJQRVHV�GLYHUWLFXORVLV�E\�FDUHIXO��SK\VLFDO�H[DPLQDWLRQ��E\�OLVWHQLQJ�WR�WKH�SDWLHQW·V�GHVFULSWLRQ�RI�V\PSWRPV�DQG�E\�RUGHULQJ�GLDJQRVWLF�WHVWV��7HVWV�WKDW�PLJKW�EH�XVHG�LQFOXGH�EDULXP�HQHPD��DQ�[�UD\�RI�WKH�FRORQ��DQG�FRORQRVFRS\��D�SURFHGXUH�XVHG�WR�ORRN�DW�WKH�LQVLGH�RI�WKH�FRORQ�WKURXJK�D�IOH[LEOH�OLJKWHG�WXEH��

Treatment of diverticulosis7UHDWPHQW�RI�GLYHUWLFXORVLV�LV�D�UHPLQGHU�RI�WKH�VD\LQJ��´SD\�QRZ�RU��SD\�ODWHUµ��:H�DOO�NQRZ�WKDW�D�KLJK�ILEHU�GLHW�LV�JRRG�IRU�RXU�KHDOWK�DQG�KHOSV�SUHYHQW�GLYHUWLFXORVLV��6R��LI�ZH�GR�QRW�HDW�D�KLJK�ILEHU�GLHW�GXULQJ�RXU�\RXQJHU�\HDUV�WKH�FKDQFHV�DUH�YHU\�KLJK�WKDW�ZH�PD\�´SD\�ODWHUµ�E\�GHYHORSLQJ�GLYHUWLFXORVLV��$QG��RQFH�\RX�GHYHORS�GLYHUWLFXORVLV��JXHVV�ZKDW�WKH�SULPDU\�WUHDWPHQW�LV"�,URQLFDOO\��LW�LV�LQFUHDVHG�ILEHU�LQ�WKH�GLHW�

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4

Diverticulitis may be present to a slight degree for quite some time with mild symptoms, but could develop suddenly, with intense symptoms.

A diverticulum may bleed, causing bright red blood to appear in the stool. The amount of blood may range from a small amount to massive bleeding.

Page 7: Diverticular Disease...1421 N. State Street, Ste 203 Jackson, MS 39202 601/355-1234 Vicksburg 1815 Mission 66 Vicksburg, MS 39180 601/638-8801 Madison 106 Highland Way Madison, MS

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How is diverticular disease usually diagnosed?7KH�SK\VLFLDQ�XVXDOO\�GLDJQRVHV�GLYHUWLFXORVLV�E\�FDUHIXO��SK\VLFDO�H[DPLQDWLRQ��E\�OLVWHQLQJ�WR�WKH�SDWLHQW·V�GHVFULSWLRQ�RI�V\PSWRPV�DQG�E\�RUGHULQJ�GLDJQRVWLF�WHVWV��7HVWV�WKDW�PLJKW�EH�XVHG�LQFOXGH�EDULXP�HQHPD��DQ�[�UD\�RI�WKH�FRORQ��DQG�FRORQRVFRS\��D�SURFHGXUH�XVHG�WR�ORRN�DW�WKH�LQVLGH�RI�WKH�FRORQ�WKURXJK�D�IOH[LEOH�OLJKWHG�WXEH��

Treatment of diverticulosis7UHDWPHQW�RI�GLYHUWLFXORVLV�LV�D�UHPLQGHU�RI�WKH�VD\LQJ��´SD\�QRZ�RU��SD\�ODWHUµ��:H�DOO�NQRZ�WKDW�D�KLJK�ILEHU�GLHW�LV�JRRG�IRU�RXU�KHDOWK�DQG�KHOSV�SUHYHQW�GLYHUWLFXORVLV��6R��LI�ZH�GR�QRW�HDW�D�KLJK�ILEHU�GLHW�GXULQJ�RXU�\RXQJHU�\HDUV�WKH�FKDQFHV�DUH�YHU\�KLJK�WKDW�ZH�PD\�´SD\�ODWHUµ�E\�GHYHORSLQJ�GLYHUWLFXORVLV��$QG��RQFH�\RX�GHYHORS�GLYHUWLFXORVLV��JXHVV�ZKDW�WKH�SULPDU\�WUHDWPHQW�LV"�,URQLFDOO\��LW�LV�LQFUHDVHG�ILEHU�LQ�WKH�GLHW�

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4

Diverticulitis may be present to a slight degree for quite some time with mild symptoms, but could develop suddenly, with intense symptoms.

A diverticulum may bleed, causing bright red blood to appear in the stool. The amount of blood may range from a small amount to massive bleeding.

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Why fiber?Fiber is crucial to both the prevention and treatment of diverticulosis, because it helps prevent constipation, reduces the pressure inside the colon and keeps diverticulosis from becoming more extensive or severe.

Although fiber (or roughage) itself does not contain vitamins and minerals, it is an important part of the diet. It is not digested, but absorbs water, which makes the stool softer and bulkier.

Many foods are great sources of fiber. Raw fruits and vegetables, bran muffins, breads and cereals, as well as cooked peas and beans are good choices, but the amount of fiber in those foods varies quite a bit. The average American diet does not contain enough fiber. For good health, the current recommended level of fiber is between 30 and 40 grams per day, yet the average American diet contains only 15 to 20 grams per day.

Once you have diverticulosis, it is necessary to continue a high-fiber diet always, unless your physician recommends otherwise. When your gastroenterologist recommends a high-fiber diet, you will be given more information about high-fiber foods that will help you choose the best foods.

Sometimes, a dietary supplement will be prescribed to provide extra fiber. These are known as bulking agents. You may know some of those by brand name: Metamucil, PerDiem Plain, Effersyllium, Citrucel, Hydrocil Instant and Miller’s Bran.

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Diverticulosis is potentially preventable with a high fiber diet.

7

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As with most health problems, the best “medicine” is prevention!

Page 10: Diverticular Disease...1421 N. State Street, Ste 203 Jackson, MS 39202 601/355-1234 Vicksburg 1815 Mission 66 Vicksburg, MS 39180 601/638-8801 Madison 106 Highland Way Madison, MS

Other Lifestyle changes5HJXODU�H[HUFLVH�DQG�SOHQW\�RI�IOXLGV��HVSHFLDOO\�ZDWHU��LQ�WKH�GLHW�KHOSV�SUHYHQW�FRQVWLSDWLRQ��$QG��SUHYHQWLQJ�FRQVWLSDWLRQ�UHGXFHV�WKH�FKDQFHV�RI�GLYHUWLFXOD�IRUPLQJ�DQG�KHOSV�DYRLG�FRPSOLFDWLRQV�IURP�WKRVH�WKDW�DUH�DOUHDG\�WKHUH��5HJXODU�H[HUFLVH�DOVR�KHOSV�SUHYHQW�FRQVWLSDWLRQ�

Other treatment$V�PHQWLRQHG�HDUOLHU��ZKHQ�FRPSOLFDWLRQV�RFFXU��RWKHU�IRUPV�RI�WUHDWPHQW�PD\�EH�SUHVFULEHG��LQFOXGLQJ�DQWLELRWLFV�WR�WUHDW�LQIHFWLRQ�DQG�RFFDVLRQDOO\��DQWLVSDVPRWLF�GUXJV�WR�PLQLPL]H�GLVFRPIRUW�IURP�FUDPSLQJ�

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Diverticular DiseaseWhat is it?'LYHUWLFXODU�GLVHDVH�LV�RQH�RI�WKH�PRVW�FRPPRQ�FRQGLWLRQV�RI�WKH������JDVWURLQWHVWLQDO�V\VWHP��DIIHFWLQJ�DSSUR[LPDWHO\����PLOOLRQ�$PHULFDQV��7KH�WHUP�GLYHUWLFXODU�GLVHDVH�LQFOXGHV�GLYHUWLFXORVLV�DQG�GLYHUWLFXOLWLV��ERWK�RI�ZKLFK�ZLOO�EH�GLVFXVVHG��$OWKRXJK�LW�FDQ�RFFXU�DW�DQ\�DJH��LW�LV�UDUH�DPRQJ�SHRSOH�XQGHU�DJH�����,W�LV�FRPPRQ�DPRQJ�WKRVH�RYHU����DQG�DIIHFWV�PRUH�ZRPHQ�WKDQ�PHQ��%\�DJH������������������������DERXW�����RI�WKH�SRSXODWLRQ�ZLOO�KDYH�GLYHUWLFXORVLV��%\�DJH�����WKH�SHUFHQWDJH�LQFUHDVHV�WR������

Diverticulosis'LYHUWLFXORVLV�LV�D�FRQGLWLRQ�LQ�ZKLFK�VPDOO�EDOORRQ�OLNH�VDFV�GHYHORS�LQ�WKH�FRORQ��7KH�VDFV�RU�SRXFKHV�������������EDOORRQ�RXWZDUG�IURP�WKH�LQVLGH�RI�WKH�FRORQ�ZDOO��$�VLQJOH��RXWSRXFKLQJ�LV�NQRZQ�DV�D�GLYHUWLFXOXP��ZKLOH�PDQ\�DUH�NQRZQ�DV�GLYHUWLFXOD��7KH\�PD\�RFFXU�DQ\ZKHUH�LQ�WKH�FRORQ��EXW�WKH�PRVW�FRPPRQ�ORFDWLRQ�LV�QHDU�WKH�HQG�RU�RQ�WKH�OHIW�VLGH�RI�WKH�FRORQ�

What causes diverticulosis?,W�WDNHV�\HDUV�WR�GHYHORS�GLYHUWLFXORVLV�DQG�LW�LV�WKRXJKW�WR�RFFXU�DV�D�UHVXOW�RI�KLJK�SUHVVXUH�LQ�WKH�FRORQ�IRU�H[WHQGHG�SHULRGV�RI�

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Table of Contents���:KDW�LV�LW"���'LYHUWLFXORVLV���:KDW�FDXVHV�LW"���:KDW�DUH�WKH�V\PSWRPV"���:KDW�DUH�WKH�FRPSOLFDWLRQV"���'LYHUWLFXOLWLV���'LYHUWLFXODU�EOHHGLQJ���3HUIRUDWLRQ���+RZ�LV�GLYHUWLFXODU�GLVHDVH�GLDJQRVHG"���7UHDWPHQW�RI�GLYHUWLFXORVLV���:K\�ILEHU"���1XWV�DQG�VHHGV���6WLFN�ZLWK�LW����2WKHU�OLIHVW\OH�FKDQJHV���2WKHU�WUHDWPHQW���6XPPDU\

9

In summary…+DYLQJ�GLYHUWLFXORVLV�PD\�EH�XQFRPIRUWDEOH��EXW�QHHG�QRW�EH�D�VHULRXV�SUREOHP��%\�IROORZLQJ�\RXU�JDVWURHQWHURORJLVW·V�DGYLFH��UHSRUWLQJ�DQ\�XQXVXDO�RU�VHYHUH�V\PSWRPV��DQG�EHLQJ�WUHDWHG�HDUO\�IRU�FRPSOLFDWLRQV��\RX�FDQ�KHOS�\RXUVHOI�OLYH�ZLWK�WKLV�SUREOHP�ZLWKRXW�VHULRXV�FRQVHTXHQFHV�

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